Vasculitides - Revision history

Michael: /* Most common{{Ref TN2005 |RH3}} */

2016-11-25T11:42:19Z

Most common{{Ref TN2005 |RH3}}

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	*Polyarteritis nodosa (PAN).		*Polyarteritis nodosa (PAN).
	*Microscopic polyangiitis.		*Microscopic polyangiitis.
	*Wegener's granulomatosis.		*Granulomatosis with polyangiitis (Wegener's granulomatosis).
	*Predominantly cutaneous vasculitis.		*Predominantly cutaneous vasculitis.
	*Giant cell arteritis (GCA).		*Giant cell arteritis (GCA).

Michael: /* Types */

2016-11-25T11:41:32Z

Types

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	*Essential cryoglobulinemic vasculitis.		*Essential cryoglobulinemic vasculitis.
	*ANCA-associated:		*ANCA-associated:
	**[[Wegener's granulomatosis~~]] (~~c-ANCA > p-ANCA).		**[[Granulomatosis with polyangiitis]] (Wegener's granulomatosis) - c-ANCA > p-ANCA.
	**[[Churg-Strauss syndrome~~]] (~~50% ANCA +ve).		**[[Eosinophilic granulomatosis with polyangiitis]] (Churg-Strauss syndrome) - 50% ANCA +ve.
	**[[Microscopic polyangiitis]] (usually p-ANCA).		**[[Microscopic polyangiitis]] - usually p-ANCA.

	Notes:		Notes:

Michael: /* Grouping by hypersensitivity */

2016-11-25T11:39:45Z

Grouping by hypersensitivity

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	*Giant cell arteritis.		*Giant cell arteritis.
	*Takayasu arteritis.		*Takayasu arteritis.
	*Churg-Strauss disease.		*Eosinophilic granulomatosis with polyangiitis (Churg-Strauss disease).
	*Wegener’s granulomatosis.		*Granulomatosis with polyangiitis (Wegener’s granulomatosis).

	Note:		Note:

Michael: /* Granulomatosis with polyangiitis */

2016-11-25T11:38:36Z

Granulomatosis with polyangiitis

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	==Granulomatosis with polyangiitis==		==Granulomatosis with polyangiitis==
	*[[AKA]] ''Wegener granulomatosis''.		:Previously known as ''Wegener granulomatosis''.
	{{Main\|Granulomatosis with polyangiitis}}		{{Main\|Granulomatosis with polyangiitis}}

Michael: /* Churg-Strauss syndrome */

2016-11-25T11:38:14Z

Churg-Strauss syndrome

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	{{Main\|Granulomatosis with polyangiitis}}		{{Main\|Granulomatosis with polyangiitis}}

	==Churg-Strauss syndrome==		==Eosinophilic granulomatosis with polyangiitis==
			:Previously known as ''Churg-Strauss syndrome'' and ''Churg-Strauss disease''.
	{{Main\|Eosinophilic granulomatosis with polyangiitis}}		{{Main\|Eosinophilic granulomatosis with polyangiitis}}

Michael: /* Churg-Strauss syndrome */ redirect -- split otu

2016-11-25T11:31:36Z

Churg-Strauss syndrome: redirect -- split otu

← Older revision		Revision as of 11:31, 25 November 2016
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	==Churg-Strauss syndrome==		==Churg-Strauss syndrome==
	*Abbreviated ''CSS''.		{{Main\|Eosinophilic granulomatosis with polyangiitis}}
	*AKA ''allergic granulomatous angiitis''.<ref name=emedicine333492>[http://emedicine.medscape.com/article/333492-overview http://emedicine.medscape.com/article/333492-overview]</ref>
	*[[AKA]] ''Churg-Strauss disease''.

	~~===General===~~
	~~Defining features - memory device ''GAFE'':~~
	*'''G'''ranulomata.
	*'''A'''sthma.
	*'''F'''ever.
	*'''E'''osinophilia.

	~~Notes:~~
	*Similar to ''[[Wegener's granulomatosis]]'' (classically c-ANCA +ve) and ''microscopic polyangiitis''.<ref>URL: [http://emedicine.medscape.com/article/334024-overview http://emedicine.medscape.com/article/334024-overview]. Accessed on: 22 January 2011.</ref>

	~~===Microscopic===~~
	~~Features:~~
	*Small vessel [[vasculitis]].
	*Abundant eosinophils.
	*[[Granuloma]]s.

	~~DDx:~~
	*Eosinophilic vasculitis associated with a [[connective tissue disease]].<ref name=pmid8708015>{{Cite journal \| last1 = Chen \| first1 = KR. \| last2 = Su \| first2 = WP. \| last3 = Pittelkow \| first3 = MR. \| last4 = Conn \| first4 = DL. \| last5 = George \| first5 = T. \| last6 = Leiferman \| first6 = KM. \| title = Eosinophilic vasculitis in connective tissue disease. \| journal = J Am Acad Dermatol \| volume = 35 \| issue = 2 Pt 1 \| pages = 173-82 \| month = Aug \| year = 1996 \| doi = \| PMID = 8708015 }}</ref>

	~~====Images====~~
	~~<gallery>~~
	~~Image:Churg-Strauss_syndrome_-_high_mag.jpg \|CSS - high mag. (WC)~~
	~~Image:Churg-Strauss_syndrome_-_very_high_mag.jpg \|CSS - very high mag. (WC)~~
	~~</gallery>~~
	=Medium vessel vasculitides=		=Medium vessel vasculitides=
	The follow section has information specific to the individual types of medium vessel vasculitis.		The follow section has information specific to the individual types of medium vessel vasculitis.

Michael: /* Wegener granulomatosis */ split

2016-08-31T16:53:14Z

Wegener granulomatosis: split

← Older revision		Revision as of 16:53, 31 August 2016
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	*[http://path.upmc.edu/cases/case260/micro.html Microscopic polyangiitis - several images (upmc.edu)].		*[http://path.upmc.edu/cases/case260/micro.html Microscopic polyangiitis - several images (upmc.edu)].

	==~~Wegener granulomatosis~~==		==Granulomatosis with polyangiitis==
	*Abbreviated ''WG''.		*[[AKA]] ''Wegener granulomatosis''.
	*[[AKA]] ''granulomatosis ~~with polyangiitis~~''.		{{Main\|Granulomatosis with polyangiitis}}
	~~===General===~~
	*Autoimmune.

	~~====Clinical====~~
	*Epistasis.
	*Renal failure - present as ''nephritic syndrome''.
	**Renal biopsy: crescentic glomerulonephritis ([[AKA]] [[rapidly progressive glomerulonephritis]]).
	*[[Pulmonary hemorrhage]].

	~~Serology:~~
	*c-ANCA +ve.<ref name=Ref_TN2005_RH6>{{Ref TN2005\|RH6}}</ref>

	~~Notes:~~
	*Pulmonary hemorrhage syndromes:<ref name=Ref_PBoD745>{{~~Ref PBoD~~\|~~745}}</ref>~~
	**[[Goodpasture syndrome]].
	**Idiopathic pulmonary hemosiderosis.
	**Vasculitis-assoc. hemorrhage (hypersensitivity angiitis, Wegener granulomatosis).
	**[[Systemic lupus erythematosus]].

	~~===Microscopic===~~
	~~Features:~~
	*Small vessel vasculitis:
	*#Inflammatory cells within the vessel wall.
	#[[Granuloma]]s - typically poorly formed.<ref name=Ref_PBoD747>{{Ref PBoD\|747}}~~</ref>~~
	#*Multinucleated giant cells - common. (???)
	*#Vessel wall injury.
	#[[Fibrinoid necrosis]].

	~~Notes:~~
	*In the lung, the [[granuloma]]s tend to be centrilobular, as the artery travels with the airway and is centrilobular.
	**It may difficult to find small blood vessels in affected portions of lung.

	~~====Images====~~
	~~<gallery>~~
	~~Image:Wegener's granulomatosis - intermed mag.jpg \| WG - intermed. mag. (WC)~~
	~~Image:Wegener's granulomatosis - very high mag.jpg \| WG - very high mag. (WC)~~
	~~Image:Wegener's granulomatosis -b- intermed mag.jpg \| WG - intermed. mag. (WC)~~
	~~Image:Wegener's granulomatosis -b- high mag.jpg \| WG - high mag. (WC)~~
	~~Image:Wegener's granulomatosis -b- very high mag.jpg \| WG - very high mag. (WC)~~
	~~</gallery>~~
	~~www:~~
	*[http://www.flickr.com/photos/pulmonary_pathology/3734403695/ Wegener's granulomatosis (flickr.com)].
	*[http://path.upmc.edu/cases/case269.html Wegener's granulomatosis - several crappy images (upmc.edu)].
	*[http://path.upmc.edu/cases/case660.html Wegener's granulomatosis - more crappy images (upmc.edu)].
	*[http://path.upmc.edu/cases/case675.html WG - more images (upmc.edu)].

	==Churg-Strauss syndrome==		==Churg-Strauss syndrome==

Michael: /* Small vessel leukocytoclastic vasculitis */ split out

2015-08-14T03:19:11Z

Small vessel leukocytoclastic vasculitis: split out

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	==Small vessel leukocytoclastic vasculitis==		==Small vessel leukocytoclastic vasculitis==
	*[[AKA]] ''leukocytoclastic vasculitis'', abbreviated ''LCV''.		*[[AKA]] ''leukocytoclastic vasculitis'', abbreviated ''LCV''.
			{{Main\|Small vessel leukocytoclastic vasculitis}}
	~~===General===~~
	*Most common cutaneous vasculitis.<ref name=pmid18948765>{{Cite journal \| last1 = Brinster \| first1 = NK. \| title = Dermatopathology for the surgical pathologist: a pattern-based approach to the diagnosis of inflammatory skin disorders (part II). \| journal = Adv Anat Pathol \| volume = 15 \| issue = 6 \| pages = 350-69 \| month = Nov \| year = 2008 \| doi = 10.1097/PAP.0b013e31818b1ac6 \| ~~PMID = 18948765 }}</ref>~~

	~~Clinical:~~
	*Palpable purpura, usu. lower extremity.

	~~===Microscopic===~~
	~~Features:<ref name=pmid18948765/>~~
	*Small ~~upper dermis vessels with:~~
	*#Neutrophils.
	#Fragmentation of neutrophils (leukocytoclasia).
	*#Vessel damage: fibrin deposition (bright pink acellular stuff).

	~~Has a very broad DDx:<ref name=pmid18948765/>~~
	~~#Infectious:~~
	~~#*Bacterial.~~
	~~#*Viral.~~
	~~#*[[Fungal]].~~
	~~#Vasculitic disorders:~~
	~~#*ANCA mediated vasculitides:~~
	~~#**[[Wegener granulomatosis]].~~
	~~#**[[Churg-Strauss syndrome]].~~
	#*[[Henoch–Schönlein purpura]].<ref name=pmid9713395>{{Cite journal \| last1 = Kraft \| first1 = DM. \| last2 = Mckee \| first2 = D. \| last3 = Scott \| first3 = C. \| title = Henoch-Schönlein purpura: a review. \| journal = Am Fam Physician \| volume = 58 \| issue = 2 \| pages = 405-8, 411 \| month = Aug \| year = 1998 \| doi = \| PMID = 9713395 }}~~</ref>~~
	~~#*Urticarial vasculitis.~~
	~~#Other:~~
	~~#*[[Connective tissue disease]], e.g. [[mixed connective tissue disease]], [[SLE]], [[rheumatoid arthritis]].~~
	~~#*[[Cryoglobulinemia]] - may be due to [[multiple myeloma]], [[hepatitis C]]; have intravascular thrombi.~~
	~~#*Paraneoplastic.~~
	~~#*Drugs.~~

	~~Image:~~
	*[http://www.ancavasculitis.com/biopsy.php LCA (ancavasculitis.com)].
	*[http://path.upmc.edu/cases/case189.html LCA of the GI tract - several images (upmc.edu)].

	~~===Stains===~~
	*PAS - look for fungus.

	==Microscopic polyangiitis==		==Microscopic polyangiitis==

Michael: /* References */

2014-12-17T07:54:21Z

References

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	[[Category:Cardiovascular pathology]]		[[Category:Cardiovascular pathology]]
			[[Category:Vasculitides]]

Michael: /* Giant cell arteritis */ split out

2014-12-17T07:52:05Z

Giant cell arteritis: split out

← Older revision		Revision as of 07:52, 17 December 2014
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	*Abbreviated ''GCA''.		*Abbreviated ''GCA''.
	*[[AKA]] ''temporal arteritis''.		*[[AKA]] ''temporal arteritis''.
	~~===General===~~		{{Main\|Giant cell arteritis}}
	*Classically afflicts the ''temporal artery''.

	~~Clinical features:~~
	*Classic finding: jaw claudication, in a patient older than 50 years.
	*Other findings: headache, vision loss or diplopia, scalp tenderness, polymyalgia, weight loss, chills, fever.

	~~Work-up:~~
	*CRP, ESR, temporal artery biopsy.
	**ESR normal (>50 years old): <20 mm/hr males, <30 mm/hr females.<ref>URL: [http://www.nlm.nih.gov/medlineplus/ency/article/003638.htm http://www.nlm.nih.gov/medlineplus/ency/article/003638.htm]. Accessed on: 17 August 2012.</ref>

	~~Treatment:~~
	*Treat right away with high dose steroids.
	**Biopsy is confirmatory.

	~~===Microscopic===~~
	~~Features:~~
	*Artery with intramural inflammatory cells.
	**Classically [[granuloma\|~~granulomatous inflammation]].~~
	***Granulomas not required for the diagnosis!
	*Destruction of arterial wall, e.g. fibrinoid necrosis (pink anucleate arterial wall).

	~~Image(s):~~
	*[http://www.djo.harvard.edu/files/5077_728.jpg GCA (harvard.edu)].
	*[http://path.upmc.edu/cases/case646.html GCA - several images (upmc.edu)].

	~~===Sign out===~~
	~~====Negative====~~
	~~<pre>~~
	~~TEMPORAL ARTERY, LEFT, BIOPSY:~~
	~~- MEDIUM SIZE ARTERY WITHOUT PATHOLOGIC DIAGNOSIS, SEE COMMENT.~~

	~~COMMENT:~~
	~~A negative biopsy does not rule out the possibility of giant~~ cell ~~(temporal)~~
	arteritis~~, as this may be a focal disorder. The clinical management is~~
	~~dependent upon the clinical impression.~~
	~~</pre>~~

	==Takayasu arteritis==		==Takayasu arteritis==